Nursing Elites

1. A client with DM visits the health care clinic. The client's diabetes has been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

• A. Atenolol (Tenormin)
• B. Prednisone (Deltasone)
• C. Phenelzine (Nardil)
• D. Allopurinol (Zyloprim)

Correct answer: B

Rationale: The correct answer is B. Prednisone is a corticosteroid that can cause hyperglycemia by increasing glucose production in the liver. Atenolol (Choice A) is a beta-blocker that typically does not affect blood glucose levels significantly. Phenelzine (Choice C) is a monoamine oxidase inhibitor used for depression and does not directly impact blood glucose levels. Allopurinol (Choice D) is a xanthine oxidase inhibitor used to manage gout and does not contribute to hyperglycemia.

2. A client with type 2 DM is prescribed metformin (Glucophage). The nurse should include which instruction when teaching the client about this medication?

• A. Take the medication with meals.
• B. Take the medication on an empty stomach.
• C. Avoid taking the medication if you miss a meal.
• D. Take the medication before bedtime.

Correct answer: A

Rationale: The correct instruction when taking metformin (Glucophage) is to take the medication with meals. Taking metformin with meals helps to reduce gastrointestinal side effects and improve absorption. Choice B is incorrect because taking metformin on an empty stomach can increase the risk of gastrointestinal side effects. Choice C is incorrect because missing a meal does not mean the medication should be avoided; the client should still take it with the next meal. Choice D is incorrect because there is no specific recommendation to take metformin before bedtime.

3. A client with DM is scheduled for surgery. The nurse should plan to:

• A. Monitor the client's blood glucose level closely during the perioperative period.
• B. Give the client a regular diet as ordered.
• C. Have the client stop taking insulin 48 hours before surgery.
• D. Hold the client's insulin on the morning of surgery.

Correct answer: A

Rationale: The correct answer is to monitor the client's blood glucose level closely during the perioperative period. For a client with diabetes mellitus (DM) scheduled for surgery, it is essential to closely monitor blood glucose levels to prevent hypo- or hyperglycemia. Choice B is incorrect because giving the client a regular diet as ordered may not address the specific needs related to managing blood glucose levels in the perioperative period. Choice C is incorrect as abruptly stopping insulin 48 hours before surgery can lead to uncontrolled blood sugar levels, which is not recommended. Choice D is incorrect because holding the client's insulin on the morning of surgery can also disrupt blood sugar control, potentially leading to complications during the perioperative period.

4. A nurse manager in the emergency department considers policy changes in the organization and changes in the community, and tries to predict how these may impact the functioning of the unit. Which of the following decisional activities best describes this manager’s actions?

• A. Resource allocation
• B. Monitoring
• C. Job analysis and redesign
• D. Planning for the future

Correct answer: D

Rationale: The correct answer is D: Planning for the future. In this scenario, the nurse manager is engaging in decisional activities related to planning for the future. This involves analyzing potential impacts of policy changes and community shifts on the unit's functioning and making decisions based on predictions and foresight. Option A, resource allocation, focuses on distributing resources effectively. Option B, monitoring, involves observing and assessing current activities. Option C, job analysis and redesign, pertains to evaluating and restructuring roles and responsibilities within the unit, which is not the primary focus of the scenario provided.

5. Which of the following ethical principles is demonstrated when a nurse provides truthful information to a patient?

• A. Veracity
• B. Autonomy
• C. Justice
• D. Nonmaleficence

Correct answer: A

Rationale: The correct answer is A: Veracity. Veracity is the ethical principle of truthfulness and honesty in communication. When a nurse provides truthful information to a patient, it demonstrates integrity and respect for the patient's right to know the truth about their health condition and treatment. Choice B, Autonomy, refers to respecting the patient's right to make their own decisions. Choice C, Justice, involves fairness and equality in healthcare decisions. Choice D, Nonmaleficence, relates to the obligation to do no harm and prevent harm to the patient.

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